NPIMap

Individual provider Active NPI

Juan Carlos Salacup Rodriguez, APRN, FNP-C

  • Family Nurse Practitioner
  • Las Vegas, NV
National Provider Identifier
1760090419
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
TEMP832426 Issued in NV
Practice address
6480 W Russell Rd
Las Vegas, NV 89118-1919
Phone
(702) 396-4165
Fax
(702) 252-4405
NPI assigned
Jul 20, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X TEMP832426 NV Primary

Addresses

Primary practice location

6480 W Russell Rd
Las Vegas, NV 89118-1919

Mailing address

6480 W Russell Rd
Las Vegas, NV 89118-1919
Phone (702) 396-4165

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201007000069 NV Practitioner - Nurse Practitioner 0749609048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infectious Disease Specialists LLCGroup PAC ID 7214974971, 12 clinicians

Practice addresses (Care Compare)

6867 W Charleston Blvd
Suite 100
Las Vegas, NV 89117-1669
Phone (702) 396-4165

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92 of 100Reported as group
Quality
100
Improvement activities
40
Cost
40.01

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
TEMP832426NVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Infectious Disease Specialists, LLC CurrentSince Sep 25, 2020 Accepting new patients
Valley Primary Care Center LLC PastSince Sep 6, 2020 Accepting new patients

Locations

6867 W Charleston Blvd
Ste 100
Las Vegas, NV 89117
Phone (702) 396-4165

6867 W Charleston Blvd
Ste B
Las Vegas, NV 89117
Phone (702) 266-6150

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1760090419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6480 W RUSSELL RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891181919",
            "telephone_number": "702-396-4165",
            "fax_number": "702-252-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6480 W RUSSELL RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891181919",
            "telephone_number": "702-396-4165",
            "fax_number": "702-252-4405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "JUAN CARLOS",
        "middle_name": "SALACUP",
        "name_prefix": "Mr.",
        "credential": "APRN, FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-20",
        "last_updated": "2025-09-11",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "TEMP832426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.